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HomeMy WebLinkAbout25552-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. e- CERTIFICATE OF OCCUPANCY No: Z-27089 Date: 05/19/00 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: 775 WOOD LA PECONIC (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 86 Block 6 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 28, 1999 pursuant to which Building Permit No. 25552-Z dated FEBRUARY 18, 1999 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION & ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ARISTIDES M & HEIDE GIOSASI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 27335 07/28/99 PLUMBERS CERTIFICATION DATED 05/09/00 WILLIAM W. DICK ut rizedignature Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27090 Date: 05/19/00 THIS CERTIFIES that the building ACCESSORY Location of Property: 775 WOOD LA PECONIC (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 86 Block 6 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 28, 1999 pursuant to which Building Permit No. 25552-Z dated FEBRUARY 18, 1999 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY INGROUND POND WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to ARISTIDES M & HEIDE GIOSASI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A c eL�1 Authorized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25552 Z Date FEBRUARY 18, 1999 Permission is hereby granted to: ARISTIDES M GIOSASI PO BOX 215 PECONIC,NY 11958 for CONSTRUCTION OF AN ADDITION & ALTERATIONS FOR AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.AMENDED TO INCLUDE INGROUND POOL. 2 COS at premises located at 775 WOOD LA PECONIC County Tax Map No. 473889 Section 086 Block 0006 Lot No. 009 pursuant to application dated JANUARY 28, 1999 and approved by the Building Inspector. Fee $ 483 . 60 Authorized Signature ORIGINAL Rev. 2/19/98 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25552 Z Date FEBRUARY 18 99 Permission is hereby granted to: ARISTIDES M GIOSASI PO BOX 215 PECONIC,NY 11958 for CONSTRUCTION OF AN ADDITION & ALTERATIONS FOR AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 775 WOOD LA PECONIC County Tax Map No. 473889 Section 086 Block 0006 Lot No. 009 pursuant to application dated JANUARY 28 99 and approved by the Building Inspector. Fee $ 333.60 Authorized Signature ORIGINAL Rev. 2/19/98 Form No. ( 7 S_ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN MALL t'j'•""g � k '2° qR, ,',p" ± s 765-1802T,a7 i:u s s; ;.. APPLICATION FOR CERTIFICATE OF OCCUPANCY .—.__. ._ A. This application must be filled in by typewriter, OR ink and submi ed to Oherjp��}��3ng inspector with the following: for new building or new use: aC�">.= -&i�'. -+'a��"°�• ' 1 . Final survey of property with accurate location of all buildings, property lines, streets, and unusual. natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-dispos2l(S-9 form) . 3. Approval. of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - .2W 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . +7 75 (,J t>OP LA Ne- Location (1e c o n1 ( L of Property. . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . } R1Fr( 9eS .r j+e'lpl? C_ o,5 &S 'l . . . . . .7J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . .() 4. . . . . .Block. . .4 . . . . . . . . . . .Lot. . . . ./• . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No a5_551 ,;- . . .Date Of Permitap .))A) 11 . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Corticate. . . . . . . . . . . Fee Submitted: $. . . . .. ... . . . . . . . . . . . . . . . . . . . . . . � . . . . . . . . . . . . . . _ s'7 qq APPLICANT C04�a,?08,9 11.11.1 .. . 7(,S �c 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL , ^�• 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY t Y { to t_ -. .. A. This application must be filled in by typewriter OP. ink and submi '�.Ko the ,building inspector with the following: for new building or new use: Li tT' 1 . Final survey of property with accurate location of all buildings , property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1 . Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions, to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - 25G 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . `77� W.b0_9 L/-IN � Location of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street /� Hamlet Onwer or Owners of Property. . . . ... ... .. . .f l�� t �e lX . . .S J County Tax Map No 1000, Section. . . .9 .. . . . . .Block. . .4 . . . . . . . . . . .Lot. . . . q . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit NoC'1k)5,55_ 2.-,R:_. . . .Date Of Permi A).j0.p.1 . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . .�... . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . ,p � APPLICANT COT- a�070 F MAY 1 6 90[13 Fax(516)765-1823 Town Hall, 536951Aaln"ixoad � H T Telephone (516) 765-1802 �;P, O,f3oxg179a3 ZIP O Soulhokl, NewYodc 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A 'P I O N DATE: Building Permit No. Owner: n nro� 1cC n16Sh3f ('pl`eas`e print) Plumber: (please print), I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this 1 day of ► dna �`Sl—� � Notary Public, �S �V—L'/!-- County CLAIRE A. PISCITELLI Notary Public, State of New York No. 01 PIS055793 Qualified in Suffolk Courfty Commission Expires Feb. 20,20�� APR 8 2000 6FF:01 D ELECTRICAL INSPECTION SERVICE INC. 375 DUNTONAVENUE EAST PATCHOGUE,NEW YORK 11772 (516)286-6642 27335 DATE: 7128199 APPLICATIONNo.ONFILE VILLAGE: Peconic TOWN. Southold ADDRESS: 775 Wood[.ane ISSUED TO: Aristides Giosasi INTRODUCED BY Ron's East End Electric LICNa: 4860 was examined on 7-28-99 and found to be in compliance with the National,Electrical Code LOCATION.- Base.. x Ist x 2nd x 3rd Attic Det.Garage Hot Tub Pool SWITCHES RECEPTACLES FIXTURES HEATERS FANS 'G.F.I. AIR.COND. 29 47 34 2 exhaust 5 x bsmnt DISHWASHER DRYER CLOTHES WASH. GAR.DISP. RANGE OVEN' WOKEDETECTOR x 30 amp 20 amp 7 FURNACE OIL GAS CIR. MOTORS BELL TRAM SERWCEDISCONNECT 3 f x WTRR A S PHASE 1 150oh OTHER EQUIPMENT Outside Resident 120amp well 150 disconnect 1 hood 2 air handlers 2 20 amp compress 2paddle fans 2nd floor - --- ------------ - -- _ .. .. HUGO S, S ` PRESIDEND BUILDINGPERMI`fNo.25552 brsanm mustnotbesu� �ymamer N pWorsmaybeidmhfie bythea'cmdmtiaU BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE �b� OGy� Town Hall,53095 Main Road p Fax(516)765-1823 P.O.Box 1179 W , Telephone(516)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD coSeptember 15, 1999 Glenn Pietramala 45 Culross Drive Rocky Point, NY 11778 ,v �eritQ.-z yaC, , RE : 775 Wood Lane, Peconic, Giosasi . / 1000-86-6-9 . To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupanc i not on file. (Enclosed) XX No Underwriters Certificate on file,,,,_. XX The check is (not on file. ) �o �.- No Health Department Approvai'6`n-f14-e:--- No final inspection has been made. i XX No Plumber Solder Certificate on file. (All permits involving plumbing being f'A issued after April 1, 1984) . BUILDING PERMIT # 25552-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 4112ilye Ae Asl shelf net be W"' crj L 1 1�4 mild Wife copv� *�.' TOP ,qea indicated hemW r 00 OW,4e M,w , V fw wh� Ib 10-11-,-- i ad.and m his bol,, 2" ,ow n '4 'AKC 0 A s, Lh f -4J W, C6 Cc �� I 0 C!'— ��*Om �Cll?ms >. 124>. w iz AMP rrig VArEO MAY 4; 19 1 CO Jo Of-4 I 'F W. TAY t-lAr TCA Ft DAnJM:M SEA L-r=V15 U I? AS `�r'-iCf-jCbe 'VAK� 7-UYL PC, 1 10 MIGH T )P WdW 7-0 INDIAN NE, Lonfm�11 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25552 Z Date FEBRUARY 18, 1999 Permission is hereby granted to: ARISTIDES M GIOSASI PO BOX 215 PECONIC,NY 11958 for CONSTRUCTION OF AN ADDITION & ALTERATIONS FOR AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 775 WOOD LA PECONIC County Tax Map No. 473889 Section 086 Block 0006 Lot No. 009 pursuant to application dated JANUARY 28 99 and approved by the Building Inspector. Fee $ 333 .60 r Authorized Signature COPY Rev. 2/19/98 N Wy wr MW 4.11 P-1 Board Of Southold Town Trustees 'r SOUTHOLD, NEW YORK PERMIT No. 40.62 DATE: July 31, 1992 K ISSUED TO ...... ..... ...Aristides Gios(ad A Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- bd titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on July 30, 19 150.00 and in consideration of the sum of $ paid by Robert_Dwyer_on, behalf of Aristides Giosa.si S of ........ N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: to construck decks with drywells on corners of house Wi as shown on survey dated March 27, 1992. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. _7 r Ln 011 1 1 rustee J, FM MA TERMS and CONDITIONS The Permittee Aristides Giosasi residing at Wood Land, Peconic N. y,, as pan of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any oper- ation performed purse t to this permit, and the said Permittee will, at his or her own expense, defend any and all suchlsuits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to Ithe complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 mos, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originallyl obtained. 4. That the work (involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will he no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall Ibe no interference with the right of the public to pass and repass along the beach between high Iand low water marks, 7. That if futureoperations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, 'upon due notice, to remove or alter this work or project herein stated without expenses to the Town R16f Southold. 8. That the said Board will be notified by the Permittee of the completion of the work auth- orized, 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. York State Department of Environmental l:Onservduuu ,ddin��46j� 7b1s19 rook, New York 11790-2356 MEOW Thomas C. Jorling Commissioner 3a a � U✓�G���C � Date: ��C , /l�/c3 7 � � 611 —URe: �/l/O t Dear Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: SL7�y� 'lam 1OV-7J -8 G -G -%, 7 75' Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal. wetlands jurisdictional boundary, as indicated above, without a permit. It is - your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or 'hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, R. N,1� Deputy Regional Permit Administrator i° LTOVWV-(N-1 �L�--- c1X93 1:J wmea��ecvciea wx �r.y .M.A... Y • -.,:....-. ..Y M v ... �. .+... u.e .n.• .. .. --_��•'i'.���_.^ry nim_r`-reinw..u+a.uu`.T.CC'fun. ��wr+a.Y.> d M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY 6 REMARKS: K r (e �� DATEVwq�- INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMIN [ ] FINAL [ ] F PLACE A CHIMNEY REMARKS: _'` ' 'o AtL DATE `-'� INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: 19A - DATI INSPECTO as�s�v 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: �-g- 4 DATE l3 �� INSPECTOR pp M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] OUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: r L DATE INSPECTOR 1 ' I1 %SII/� � ✓ %. . 10 ._. Ao 10; - � _ ll - ifi�1Fill iiiiiii ��/�/II�_� _� '�L/ '� ����'I►�LIi _i,.a1 r ,a �a2 .a.�r �. ._ �.. i VIM p 'ROM r BUILDING PERMIT REVIEW CHECK LIST Application Name: Architect/Engineer: Date Submitted: SCTM #: District: 1_.000 Section: Block: Lot: Subdivision Name: 795 tooo�) Req. Req. Zoning District: [Lot size: Actual: ] [Lot coverage y�.Prroopposed: ] Req )�[R� iN�—� p�O Q�i�5 R�,d e Pid q: [Front Yard Proposed: �,\, Si e a d Pro s ] [Rear and pose ] Project Description: � rr� 5ecc�n Cfi �9 6� AGENCY PERMITS Permit REQUIRED FOR REVIEWN.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Le-*C,L f ►� JU�I S bicra - Town Trustees q d (-,9-" Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Notes• e-00 � X 6� iz9 -6 xe2 - �� _ 2 , BOARD OF HEALTH JAN 192000 Gt„•' ? FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . 7 BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: / p CALL .��. !. .( Exami .................. 20.... MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved......�..2C7....,7,08 C9 Permit No. ..ole..!...a ................................... Disapproved a/c .................................. *EMMEDIATEW (Budding Inspector) "CUDSEFOO MOS PPLICATION FOR BUILDING PERMIT W'DNCOMPlE1 O / ofmoft1w Date. . . . . . . . . INSTRUCTIONS a. 'this application most be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector mill issue a Building Permit to the applicant. Such permit shall bekept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APP4CATICN IS HEREBY MARL to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections, ..�...l ..A t�!�.�A. ........... (Signature of applicant, or name, if a corporation) . ........... ..... ...................... (Mailing address of applicant) q�-cq State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................. .... ......................................................................... Name of owner of premises .. A 1<73F 80"Amoloe �p S � ............... ......................................... t T1AVi�7�ii"k (as on gfT � cisix st aeed> APMMAS NMIf applicant r noration, signature o ffiV zed officer. ;ZtQW61flftTMEM:fT;A(Name and title of corporate officer) "S-1902 9 AM TO 4 FM FOR THIt Builders License No. ......................... 0 #OLI.OVRNG INSPECTIONS:tr FOUNDATION -TWO REQUOU Plumbers License No. ......................... a ROUQH • FRAMING A PuMeme Electricians License No. ..................... Q INSULAMN Other Trade's License No. .................... 4 FINAL • CONSTRUCTION MUSTSECOMFLETEFORC.O. 1. Location of land on which proposed work will be done.............. 0Q�IS.TAU.QTIO)I.8J LLin"........... -- It R 1 WNTF THE N�Y 7.'5...� �° ..� ........P�GoN � � ... TAj� ONST (II ! 4� .......... House lumber Street OOE$: Ni3# NN91BLE FOR 710N ERRORS County Tax Map No. 1000 Section ................ Block ................ lot ................ Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................... mrddt r�•+p0 . . Y9 4 lAYC ........ b. Intended use and occupancy .. ..... .....• ........... „,m..•{3� rLt 74'.85:>s'�s; -,0'tr' ........... Nature of work (check which applicable):lil ' cable): New Building .......... Addition .......... Alteration .......... Repair ............ Ranoval 1� ....... Demolition ............ Other Work ........F�..°!.Ve.�... s�. +r•, C' •.••. I (Description)'' `" EstivtedCost ... }...... fee .............................................. (to be paid on filing this application) If dwelling, number of dwelling nsiits ............ Number of dwelling units on each floor ................ Ifgarage, txnber of cars ...................................... If business, connercial or mixed occupancy, specify nature and extent of each type of use...................... Dimensions of existing structuresl� if any: Front................ Rear ............... Depth ................. Dimensions of same structure with altera of Stories ..,..s.....,nt ....... Height ... ...... ' alterations or additions: Front .............•. Rear ............... Depth .................... HeighC'I .................... Naber of Stories ............... Dimensions of entire new construcition: Front ................ Rear ............... Depth .............. Height ......................... "r of Stories ..................... Size of lot: FrontRear .................... Depth ..........•'•Tw� a � 0. hate of Rurchase ............. ..... Name of Former Owner ........................i ND 0't 0.413,610"I alAi,oW Hlim I. Zane or use district in which pre'nises are situated .................................. AW 2. Does proposed construction violate any zoning law, ordinance or regulation: ........................ 3. Will lot be regraded ............I........ Will excess fill be removed from premises: YES NO 4. Names of Owner of premises ......I..................... Address .............................. Phone No. .............. None of Architect .................................... Address .............................. Phone No. .............. Nameof Contractor ................................... Address ...............................Phone No. ....... ....... S. is this property within 300 feet of a tidal wetland? * YGS .......... ND .......... *IF YEs, SODH1fHD mm TC mms PI MAY HE l VIREO. PI.OT DIAGRAM Locate clearly and distinctly al� buildings, whether existing or proposed, and indicate all set-back dimensions rom property lines. Give street and block nuaber or descrip on according to deed, and show street nares and indicate a)metlmer interior or corner lot. ^�� , «IMMEDiAroEIOOS ENGLOSE POOL uPONGOMNPL010% ONDERWR� �° W� 6EFOiiE 3dA'LE OF NW YORK, .:YN ll(1< FY"rr 41M1 XMIT OC .... T.N.O 1 u r A B 06$•u14� J ' lEI In6$ EV1l(k1Ri� �.1 m ceruses a t�t�uon ...�. m ine--duly--swoni t says that be is Cbe applicant (Nam of individual. signi above named, tPlamm Na ND1lOM ice is the ....'4' �(Co tracA' w�eI$��,lt� .. ..............I....-................................. �rljud. vft� JJAH (Contracts 67icer., etc.) of: said owner :�.IJ1'm°�, ,q�l :$ j � perEornn or have mer&nnecl the said work and Co make and file Chis application; il)lTAftapplication are true to time best of his knowledge and belief; amyl that the work m>S13rorth in the application filed therewith. Sworn to bbeforeepe`VA1401TOURTi2M 0 80 M01830 1 .!.. .....day of � � Notary Publi� ....A?r...[ !1 B� a� NO PUBLYNLIC,StsaONENpINWfk (Signator c Applicant) No.018060201 32 Qualified In Suffolk Go Term Expirea Marsh$,2 1 ZONE AES (EL 8) ' `, e ; s ry e a ZONE s e ' ZONE VE V\ EL 81 6 -�gm- ZONE m-ZONE X wN A \ V A A \ V A \ \\ V \ A \ V%J*611 ZONE(EL VE FLE ZONE X \\ \ \ \ \ \ \ \ \\\\ \\\\\ BAY o \ ZONE X 90 mFc� iry ZONE o X eon \ ZONE X oNOPa N ����.�.�) z ZONE X ZONE X m ZONE AE a (EL 8) D z Z . m COASTAL BARRIER x 9 � IDENTIFIED 77-16-90 o 0Z �L (SEE COASTAL BARRIER LEGEND) 3 ZONE AE u (EL 8) 5 �s o a, Town of Southold 90 360813 � 1 7-) 4Vil\\U V• I�udyay �l) + FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . JAN I BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . .. . . . . . . . TOWN DGOF PEPNOLD SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: �/.��/�. . • • p CALL l Esaminned.....l..v.:��!...... 19a9. rr MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved.......... �.. ., 19 R� Permit No. StiJ J a : Disapproveda/c .................................. .................................... (Building Inspector) PPLICATION FOR BUILDING PERMIT ��77 Date.` )8. . . . . . . . ., 19.99. INSTRUCTIONS a. 'Ibis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wil 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HMW MATE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether-applicant is Qwner, lessee, agent, az rtect, engineer, general contractor, electrician, plumber or builder :.�A 1.1.�AN`�....lS.,.. Ccs pp..C0�1.ti�r M�?� .....`..L...../.�....................... Name of owner of premises .GI. SJ,r 5..l.....�.I��. TF).f4�T..J.ltc...�....1.7��.L11C.................. (as on the tax roll or latest deed) l If applicant is a corporation, signature of duly authorized officer. ......................................................... (Nam and title of corporate officer)) Builders License No. .J 2.1�!.V.......... PlumbersLicense No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. Location of land on which proposed work will be done.. %.C. .. ©Q 11....� ��.................. . ;� �/.:....11..9. 8........................................................................ House Nu ber Street p / Hamlet Canty Tax Map No. 1000 Section �/.9aF&J.... Block ..�4�..... ... Int ...... Subdivision ...................................... Filed Map No. ............... Int ............... (Name) 2. State existing use and occupancy of premises andintended use and occupancy of proposed construction: a. Existing use and occupancy ..... L//�.. 1'�11!ilLy.... &,'(.`V' A .................................... b. Intended use and occupancy ....1.... 5!^.(16...: ii:Q � 1t?;Ei'�J .............................. -W ;.f*,��r4'7,i: 1 3. Nature of work (check wl:idr applicable): New Building .......... Addition ,. Alteration••-: - • Repair ............ Removal ...:......... Demolition ............ Other Fork ..... E (Description) 4. Estimated Cost ....4.Zf.'R 0..... fee .............................................. r (to be paid on filing this application) UIf dwelling, mri:er of dwells ':nits .. ......... timber of dwelling units on each floor ................ tx If garage, nber of cars .......&.i;2L ................. .i� If business, commercial or mixed occupancy, specify nature and extent of each type of use.............. .T/­ 7. rr�� � p.I ,77 7. Dimensions of existing structures, if any: Pront..H../. .I1.. Rear . .{.?.--A.... Depth .,JQ ... ..... Dnmensionso f sore stycturree with timber of stories ,tions. Height Y ...!.?... C6 •• ' �h alt ations or additions: Front .... Rear .....l..L.��.. Depth ..... Hes_ ... ............ Number of Stories .. .......... 8. Dimensions of entire new construction: �A • lFront ..L( .... Rear 7 !: ..... Depth Ll�...�f.... Height .... �..' ()........L Number of Stories .....r� ........... Ckrza 9. Size of lot: Front ...? c•qS ? RearDepth r nn ` n 10. Date of Purchase :.............,I...... bane of Former Owner J1�1 4� .. ..�! >J Q � ...... IIZone or use district in which xamises are situated .............................................................. 12. Does proposed construction violte any zoning law, ordinance or regulation: ...N Q............... d�� �~ 13. Will lot be regraded b......... Will excess fill be removed from premises: YES NO 1 N(Y�(L regr ..Q.�. ��- n 9 l�lo✓n 14. Names of owner of breis j7 I.C t P2 i { � Address ..�l S.�!�Ri2�.( ^ .� CJ v'PtCane l ��l z`��. Name of Architect ... ir7� J........ Address ................... Phone No. /..! Yl.. c/s 5" 12oss a�, Name of Contractor ............i............. Address .,,;//4c22F..Phone No. � _.: Q�� 15. Is Oils property within 300 feet of a tidal wetland? * YES ...Y..... NO .......... 3 *IF YES, =MD 1DWtt TR MEE3 PRMT MAY HE MWIRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block amber or description according to deed, and show street awes and indicate whether interior or corner lot. SC I I cvv".�C'q-, xc�07- F6)- `�ez�srD EN��� (�zc� z l� razor- aUF/t_, SrNtr of NW YORtt, 8S amly OF ....................... .................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, f lie is the ........�� ��W(� .� ....���11 t� L .....:.......................................... (Contractor, agent, 'Icorporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the beat of his knowledge and belief; and that the work will be perfonmed in die manner set forth in the application filed therewith. Sworn to before this L C✓ nn .. ......�... ........day of , ..19... .. UUU V,41LENS b.HQRNB, Notary PublictlfNewYork 13 No. 684 ..... ..... .... ... ...... Qualified InSuffolk CounfIR;� ,r„moo .� A nlirmfl Commission Expires May 22. 1y I V C RICHMOND RF �: t� r;.;.••rum r:°,: Ic DOCK Ulf, a D Enatrcn 7"^''ol ur,i:;w Ye,!.5•,:�,'r .`\ ORD. "W IGLI WATER M1AiZk- :, Cnplas of Oda vmvo, mna cot I •'.rirq `: 13, 87' 3✓4•$, tha matl survaY"'•.mud;''.•I; gl.KO;' "TS.OZ trt,,,,$ad 505,Shall n]1.0R llelde0d .„ r� DOCK tot t valid iruo ccpri Ouerantaaa Indteetvd haraor shell rf „ only to Uw phreon lar v0a;,p 0n a +oY Is preaarad,and on his hr L! to 'Yond . lido orannany,dovernmentnl r " •tv / �..I lark!] vIndiuni+,nliatadb ill If �1 BURN4R -f7 ' to to Gul.c nwof d:aIItI)I�`1I, — j / l��ED.AvvnoO c`l tetlnn.QUL(Ar,:uH aran ot 11 Cll"+:a Ohl. ,•.---� t toadtlitionel lnctilutions ar eutaa7uanl - "p,h1D .\V F{p L.E t, �r{'D �'p�t4 ttal j, owners. li, MAP of LAND :i Qf SURVFYI!U FOR 'Q ,: WELLS -A>z T NW ai• o `prcoo b In N T �•�a Y N D M Am to o vlorz2zln peaGt{ I l .. 4.. L... 1 ' Y 4.. N �"'.I , � U11% , I MAD YN ' A o � ' d`WJ A7 „• tf. t Pr-- C (JN IC IYIW to '`'; TOWN OF SOUTHOLD, W.V. SCALE- 1 50 - 1 M MONUMENT J„�'� :J ¢, > 1p ?� ( , T Ex OI s ' at All 7 1. l 1 4 roI 75.0 0 ., Fie e L 4. r I , 4 ,�. .''ri• I 333.Q8 tt t (Z�Cµ't 0� �' GUARANTR56 "To:;'ftIF F1' Mr TI �L6 Di �._• 2(� CHICAGO TITL6 :•INSURANCP COMPANY ANO '`'N, j i TILE SOUTHPI- $,_AYINGS ,13ANK K ; % SuRVEYCa„U; Dr1CFMRE41 2.10`567 t C { IOIRIGWT OF WAY VAN TO `.T•� Yl_ a `aGN 5 ' INDIAN NECK ROAD Z; r. LICFNBEt) } AN sunv(Y,pa5 c3kFF.rlPcik i, N 4 YORK €' J0W 2 3 �. . _ ; %Towiu'or'sgU M rL3i .W. VA Ir Area ror a inKrr •.: i O G . .msi shag r"bs W,.: �ju p .R t r �._;L'=Ott':. + "4 .._ alw true copy. 0 "Ma macs""he vm r a » �for who" d feel * o CS 25 ' e Pand on r 4 (CNr Cf?LfEfZ' s :2 Y 1 4 i r t 71 C C 7 _cv, l itis. � ,i+Y" d �.•«_,,, ...... .,._.. ,,. _ ..... ...... .. .. M 3 .g ••- E DAM:T-GAN SES. VC) r► ,� �� '� t rRyrw A NXI a